Exam 4- Chronic Kidney Disease Introduction

Question 1

Define CKD?

Answer 1

3 or more months of function or structure abnormalities in the kidneys.

Question 2

Differentiate between structure vs. function abnormalities?

Answer 2

Structure: albuminuria greater than or equal to 30

Function: Decreased GFR (below 60)

Question 3

What are the 3 most common causes of CKD?

Answer 3

• Diabetes
• HTN
• autoimmune disease (glomerular nephritis)

Question 4

Name the progression factors of CKD excluding the CAUSES of CKD.

Answer 4

• Albuminurea/Proteinuria
• dyslipidemia
• smoking
• obesity
• lead exposure
• illicit drug use

Question 5

GFR Categories

Answer 5

G1: greater than or equal to 90
G2: 60-89
G3: 30-59
G4: 15-29
G5: BELOW 1

Question 6

Name the example of the autoimmune disease mentioned in class?

Answer 6

glomerulus nephritis

Question 7

How do we stage for CKD?

Answer 7

CGA

Cause
GFR Category
Alubuminuria Category

Question 8

What it the preferred method for CKD staging?

Answer 8

CKD-EPI (CKD- Epidemiology Collaboration) equation however for the purposes of this class we will use GFR Cockcroft Gault Equation

Question 9

Increased levels of albumin are seen in in which type of patients? (think cause)

Answer 9

HTN
Diabetes
glomerular disease

Question 10

Name the albuminuria staging categories.

Answer 10

A1: less than 30
A2: 30 to 300
A3: greater than 300

Question 11

As GFR decreases what happens to SCr?

Answer 11

It INCREASES

Decrease in GFR= INCREASE in SCr

Question 12

What six factors can cause CKD Complications?

Answer 12

M2PACE

M- Metabolic acidosis
M- Metabolic bone disease 
P- Pruritius, Malnutrition, uremic bleeding
A- Anemia
C- Cardiovascular Disease 
E- electrolyte + fluid disorders

Question 13

When are symptoms present in CKD stages?

Answer 13

Stage 1- 2: ASYMPTOMATIC (silent killer)
Stages 3-4: minimal symptoms
Stage 5: MORE symptoms

Question 14

What 6 signs of CKD are seen in stages 3 through 5?

Answer 14

CHEF- UG
C-Cardiovascular/Pulmonary 
H- Hematologic 
E- Endocrine
F- Fluid/electrolytes
U- Uremic Symptoms 
G- Gastrointestinal

Question 15

What Lab values should be monitored in CKD patients?

Answer 15

SCr (BUN)
AER
GFR
K (potassium)
Glucose 
Phosphate
CO2 (carbonate)

Question 16

What are the 2 goals of CKD therapy?

Answer 16

• SLOW the progression

- MINIMIZE/MANAGE associated complications

Question 17

Progression modifying therapy:

GFR less than 30
+/- diabetic

Answer 17

No more than 0.8g/kg/day protein

Question 18

Progression modifying therapy:

At Risk of CKD progression

Answer 18

No more than 1.2g/kg/day protein

Question 19

Progression modifying therapy:

Fluid retention

Answer 19

Lower Na intake to less than 2 g/day

Question 20

Progression modifying therapy:

Physical activity

Answer 20

Exercise 30 minutes 5 times/week

Question 21

Progression modifying therapy:

Diabetes control

Answer 21

A1c ~ 7%

Question 22

Progression modifying therapy:

HTN

Answer 22

JNC-8 Goal less than 140/90 treat with ACE/ ARB

Question 23

Progression modifying therapy:

AER greater than or equal to 30.

Answer 23

Treat w/ ACE/ARB to decrease proteins

Question 24

Progression modifying therapy:

Dyslipidemia

Answer 24

ACC/AHA guidelines

Statin treatment

Question 25

Progression modifying therapy:

Smoking

Answer 25

Smoke cessation

5A’s

Question 26

Name 4 NON-pharmalogical therapies for treating the progression of CKD.

Answer 26

Lower protein intake to no more than 0.8 g/kg/day for patients w/ GFR below 30

Lower protein intake to no more than 1.2g/kg/day in patients at risk for progression

Lower Na intake to less than 2g/day

Exercise for 30 minutes 5 times a week